Provider Demographics
NPI:1376063818
Name:FEUILLERAT, JAY (DDS)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:FEUILLERAT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 N. ACRES RD. SUITE 102
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54021
Mailing Address - Country:US
Mailing Address - Phone:715-953-0499
Mailing Address - Fax:
Practice Address - Street 1:1435 N. ACRES RD. SUITE 102
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:WI
Practice Address - Zip Code:54021
Practice Address - Country:US
Practice Address - Phone:715-953-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice